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Manual Therapy – How Hands-On Therapy Can Work for You

In the Physical Therapy world, there are a number of techniques that fall under the umbrella of what we refer to as “manual therapy.” Many of the techniques share overlap with different providers including massage therapists, ”rolfers,” chiropractors and other bodyworkers. Today’s post goes in-depth on what the different types are, and when they may be useful to help you treat your particular type of pain and/or injury.

The explanations of these techniques will primarily focus on their physiological or “direct effects” on the tissues they are being applied to, but it is important to note that they all have “nonspecific effects” that account for a lot of their effectiveness. These include giving sensory input to the brain through tissues, changing how the nervous system perceives a specific movement, and other mechanisms that are not as well understood.

Soft Tissue Mobilization – This is the category with the biggest umbrella and consists of massage (with a variety of techniques), trigger point therapy, and can be combined with movement for varying degrees of aggressiveness. In the therapeutic world, it is primarily used to decrease muscle soreness and spasm, improve blood flow to tissues, and improve movement by decreasing “tightness.”

Joint Mobilization – This is a technique specific to joints of all kinds, to improve specific types of motion and mobility. It focuses on the ability of the joint surfaces to move smoothly upon each other and make sure that the capsule that surrounds the joint is not restricting motion. The ball-and-socket of the shoulder joint is a good example of this, which can become painful if it does not have freedom of movement in all directions. Joint mobilization for those with arthritis, stiff/painful joint movement, or who have been immobilized following injury or surgery.

Joint Manipulation – This is essentially a subset of joint mobilization, which can be referred to by several different terms. It can be referred to as thrust manipulation/mobilization, HVLAT (high velocity, low amplitude thrust), or “adjustment” in the chiropractic world. They are most often applied to the spine (neck or back) but can be used at nearly any joint in the body.

Many of the techniques are similar to those used in joint mobilization, but applied at high speed through a very small range of motion. These techniques are often accompanied by a cavitation or “pop,” but this isn’t necessary for the technique to work. They are often used to improve range of motion, decrease pain and stiffness, and rapidly improve movement. What they do not appear to do is affect the actual position of a joint or “re-align” things - the research is very clear on this.

Instrument-specific Types – As you might expect, these involve the use of specific tools, including metal or plastic tools for scraping muscle/fascia, which has been shown to have more to do with sensory input than changing the qualities of tissue. Needles are also used for trigger point or muscle spasm release, in a manner that is similar to acupuncture, but relies on anatomy-based placement rather than a proposed system of energy lines in the body.

Compression and decompression techniques can also be applied to theoretically improve the ability to levels of tissue (skin, fascia, muscle) to slide on one another and improve restricted movement. This can be accomplished with “cupping,” which creates a pressure vacuum, or “flossing” which involves compression wrapping – both of these techniques are often combined with movement. Other instruments that can be used to self-mobilize or “release” tissue include bands to create joint space, foam rollers and lacrosse/mobility balls to compress soft tissue. These can be a helpful adjunct to use independently and can recreate some of the effects of manual techniques.

It is important to think of these techniques as “resets” or a window of opportunity through which to move with less pain and restriction in order to move in the direction of an exercise-based therapy that can sustain long-term changes!

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